A Retrospective Study of the Management of Hirschsprung’s Disease at a Tertiary Healthcare Facility in Africa

Background: In low- and middle-income countries (LMICs), delayed diagnosis of Hirschsprung’s disease (HD) can lead to severe complications, including malnutrition and chronic constipation. This study examines patient experience and surgical outcomes for HD diagnosed beyond the neonatal period in an LMIC. Methods: A retrospective review of HD patients at a tertiary institution in sub-Saharan Africa was conducted to evaluate clinical characteristics, surgical interventions, and outcomes in patients with HD, including Wilcoxon rank-sum tests for non-parametric comparisons and univariate logistic regression to assess predictors of stoma placement. Results: Among the 61 patients (72.1% male), the average diagnosis age was 4.4 years. Short-segment HD was most common (68.9%), with the most frequent symptoms being constipation (70.5%) and abdominal distension (45.9%). Before referral, 48.6% had stomas, with older patients more likely to have them (p = 0.002). Pull-through surgery complications included strictures (17%) and requiring anal dilation (18.9%, N=53). Unfortunately, seven patients died, three before the pull-through surgery due to HD complications. Conclusion: Delayed pull through surgery was a common occurrence for patients with HD presenting after the neonatal period. Early detection with referral to surgeons with adequate resources is essential.